Starting a care business in Ohio

For adult residential care, the department depends on headcount and nursing. Ohio has no license called assisted living: a home with 17 or more unrelated residents and personal care for at least 3, or a home with 3 or more unrelated residents that gives personal care to at least 3 and skilled nursing to even one of them, is a residential care facility licensed by ODH for $320 per 50 beds. A home that gives only supervision and personal care to 3 to 16 unrelated adults is a Class Two residential facility licensed by DBH for a $75 application fee, whatever the residents' age or diagnosis. A Class Two license is needed even for one or two residents if they have a mental illness or receive the Residential State Supplement, and Class Two staff may not administer medication.

In-home care has been licensed only since October 1, 2022, under Revised Code Chapter 3740. Agencies sending workers to bathe, dress, toilet or feed clients need ODH's nonmedical home health services license. Nursing, therapy or medical social services need the skilled home health services license, which also covers nonmedical care and requires Medicare certification, CMS-approved accreditation, ODA certification or a notarized attestation that you meet the Medicare conditions of participation. Both cost $250 and last three years; new businesses also file a surety bond of $20,000 (nonmedical) or $50,000 (skilled). Neither the statute nor ODH's rules say whether a companion-only or housekeeping-only business needs a license, so ask ODH in writing.

Child care counts children present at one time. A Type B family child care home cares for 1 to 7 children in the provider's own residence, a Type A home for 8 to 14, and any site that is not the licensee's or administrator's residence with 7 or more children needs a child care center license. Type A homes and centers must be licensed; Type B homes need a license to be paid with publicly funded child care, and the statute does not say plainly whether a private-pay Type B home may run without one. Home applications cost $25 and are inspected by county job and family services agencies; center applications cost $50 and DCY inspects. Every new license is provisional for at least 12 months.

Expect renamed agencies and renumbered rules in older material. The child care rules moved from 5101 to 5180 numbering on January 2, 2025, and DCY rewrote them effective July 1, 2026: a labeled site plan replaced the plan of operation, and violations now score 3 or 6 points. House Bill 96 (2025) renamed OhioMHAS the Department of Behavioral Health, though most Class Two rules still use the old name.

Adult day care has no Ohio operating license in the Revised Code or the Administrative Code. To serve clients in ODA-administered programs such as PASSPORT, an agency provider can be certified by ODA under OAC 173-39-02.1 for enhanced or intensive adult day service. Ohio's certificate of need applies to nursing homes, not to residential care facilities, and it is not a condition of either home health license. Medicaid-funded assisted living additionally requires ODA certification of a licensed residential care facility, including a single-occupancy unit with its own bathroom for each waiver resident, unless the resident chooses to share.